Independent Bill Review (IBR)

Medical treatment and medical-legal billing disputes are resolved through an independent bill review (IBR) process. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill may apply for IBR. IBR applies to any medical service bill where the date of service is on or after Jan. 1, 2013 and where the fee is determined by a fee schedule established by the DWC.

Application process

A medical provider who disputes payment for medical service or medical-legal billing must submit a timely request to the claims administrator for a second review of the bill. If the provider disagrees with the outcome of the second review, they may request IBR within 30 days after service of the second review decision.

To request IBR, the medical provider must submit an application for IBR either electronically or in hard copy. An application for IBR can be completed and submitted electronically by registering as a user on the Maximus Federal Services IBR tracking system.

If submitting in hard copy, the following information should be included:

A medical provider can request that separate medical billing disputes be consolidated as part of IBR. Separate requests for IBR must be submitted as part of the initial IBR request and must meet criteria specified in the IBR regulations.